自体脂肪移植隆乳术的临床效果观察

Clinical effect of breast augmentation by autologous fat transplantation

目的：探讨自体脂肪移植在美学乳房增大手术和乳房重建术中的临床效果,为脂肪移植的标准化操作提供临床参考。方法自2011年7月至2014年12月,共对49例患者（95个乳房）行自体脂肪移植隆乳术,其中,单纯乳房增大术45例（90个乳房）,乳腺切除术后3例（4个乳房）,先天性疾病1例（ Poland综合征/1个乳房）。从患者腹部和大腿部获取脂肪,3000 r/min离心3 min,18 G钝头针扇形注射,主要注射层次为乳房后间隙和乳房皮下组织层。术前术后照相、X-ray和超声检查,评价手术效果。结果所有患者中,除4例接受2次或2次以上手术外,余均为1次手术。注射量：左侧乳房平均161 ml,右侧乳房平均157 ml。随访3∽24个月,21例（42.86%）满意,25例（51.02%）改善,3例（占6.12%）不满意。术后经B超和X-ray检查,2例患者有结节形成,可与癌症包块鉴别。结论自体脂肪移植隆乳术或乳房再造术,可以获得良好的长期乳房增大效果。保证移植的脂肪颗粒最大程度地获得与受区的接触面积,是提高脂肪移植存活率的关键。

Objective To investigate the clinical effect of breast augmentation and breast reconstruction by autologous fat transplantation, providing references for the standardization of autologous fat transplantation. Methods From July 2011 to December 2014, 49 patients （95 breasts） undergone breast augmentation by autologous fat transplantation, 45 patients（90 breasts） undergone breast augmentation alone, and 3 patients（4 breasts） undergone breast resection, and 1 patient （1 breast） had congenital absence of the breast. Adipose tissues acquired from abdominal and thigh were centrifuged at 3000 r/min for 3 minutes. After centrifugation, the adipose tissues were injected behind the mammary gland and subcutaneous tissue layer with 18 G blunt needle attached 2 ml syringe. The photographs, X-ray and ultrasound examination before and after operations were taken to evaluate the efficacy of the procedure. Results All patients underwent once operation except for 4 patients with 2 times or more than 2 times operation. The average quantity of autologous fat injection was 161 ml in the left side of breast, and 157 ml in the right. All patients were followed up from 3 to 24 months. 21 patients （42. 86%） were satisfied, 25 patients （51. 02%） improved, 3 patients （6. 12%） not satisfied with the postoperative effect. Nodules were found in 2 patients under the X-ray and ultrasound after operation which were identified with cancer masses. Conclusion The transplantation of autologous fat for breast augmentation and breast reconstruction can get good long-term effect. To guarantee maximum contact area of the autologous fat transplanted with the area of providing fat is the key to improve the fat transplantation survival rate.